As more people live to old age, identifying resources that enable maintenance of good quality of life during the final years of life assumes increasing importance for those committed to enhancing public health. Major gaps exist in our current knowledge of factors that contribute to health care that promotes physical comfort, psychological well-being and meaningfulness during the final years and months of life. We propose and aim to test a conceptual model focused on proactive adaptations by patients and responsiveness of their formal and informal care providers, as playing key roles in enhancing quality of life close to the end of life. We propose a four year longitudinal study of a representative sample of diverse older adults dwelling in three urban settings, to examine quality of life trajectories and their determinants. Annual face-to-face interviews and four and eight month telephone follow-up interviews will be conducted with 900 older adults (age 75+) who are participants in our ongoing NIA funded study of successful aging. Our prospective study will be complemented by interviews with next of kin of respondents who die during the course of this study in order to obtain a retrospective account of the older person's end of life care. At the conclusion of the study, we will be able to describe health, functional status, social support, and quality of life trajectories of respondents who die during the study and those who survive. The proposed study will provide information on the nature of changes in stressors posed by ill health and critical incidents, changes in ameliorative resource use, and in quality of life outcomes for racially diverse older adults. Our conceptual framework and measures we selected will allow us to offer a more holistic view of the intersection of health care and maintenance of the integrity of the person that follow from traditions of nursing research. Findings of the study should yield systematic guidelines for nursing interventions based on patient education and specialized training for nurses and other health care providers that can help promote patient-centered health care. ? ? ?
